Lang E et al. 2006 "Impact of an electronic link between the emergency department and family physicians: a randomized controlled trial."

Reference
Lang E, Afilalo M, Vandal AC, et al. Impact of an electronic link between the emergency department and family physicians: a randomized controlled trial. Can Med Assoc J 2006;174(3):313-318.
Abstract
"Background: Electronic information exchange is believed to improve efficiency and reduce resource utilization. We developed a Web-based [system] that enables family physicians to receive detailed reports of their patients' care in the emergency department. We sought to determine the impact of the SCS on measures of resource utilization in the emergency department and family physician offices. Methods: We used an open 4-period crossover cluster-randomized controlled design. During 2 separate 10-week intervention phases, family physicians received detailed reports of their patients' emergency department visits over the Internet, and in the alternating control phases they received a 1-page copy of the emergency department notes by mail. The primary outcome was the number of repeat visits to the emergency department within 14 days of the initial visit. Secondary outcomes included duplication of test and specialty consultation requests by the emergency and family physician. Outcomes were measured using the hospital database and questionnaires sent to the family physicians. Results: A total of 2022 patient visits to the emergency department from 23 practices were used in the study. Use of the SCS failed to reduce the number of repeat visits to the emergency department within 14 days (odds ratio [OR] 1.10, 95% confidence interval [CI] 0.8 - 1.51) and 28 days (OR 1.01, 95% CI 0.8 - 1.27). There was no significant duplication of requests for diagnostic tests between the emergency and family physician during the intervention and control phases (24 v. 22, p= 0.93), but there was significantly greater duplication in specialty consultation requests in the intervention phase than in the control phase (20 v. 8, p= 0.049). Interpretation: An electronic link between emergency and family physicians did not result in a significant reduction in resource utilization at either service point. Investments in improved electronic information exchange between emergency departments and family physician offices may not be substantiated by a reduction in resource utilization."
Objective
"To determine the impact of the [health information exchange (HIE) system] on measures of resource utilization in the emergency department and family physician offices."
Tools Used
Type Clinic
Primary care
Type Specific
Family practice
Size
Large
Geography
Urban
Other Information
The study was conducted at Sir Mortimer B. Davis - Jewish General Hospital (SMBD- JGH) in Montreal, Canada.
Type of Health IT
Health Information Exchange (HIE)
Type of Health IT Functions
Family physicians "received detailed clinical information of their patients' visit to the emergency department through a secure Web-based [HIE system]. The ... program automatically issued advisory e-mails once per day (at 0700) to all family physicians whose patient or patients had presented to the emergency department within the previous 24 hours. The e-mail also provided a link to a secure Web page where the family physician could view and print a medical report with details of the emergency department visit, including the patient's name, presenting symptoms, emergency department diagnosis, disposition (room assignment if admitted to hospital), specialty consultation reports, laboratory test and electrocardiography results, imaging reports, discharge planning information and suggested follow-up, as well as any new medications or modifications to existing medication regimens. Emergency physicians were aware of which patients were having ... reports issued because the names of the family physicians receiving ... reports were posted in the emergency department."
Workflow-Related Findings
"The [system] failed to reduce the number of repeat visits to the emergency department within 14 days (97/814 patients in the intervention phase v. 88/802 in the control phase) and 28 days (138/814 v. 135/802) as well as hospital admissions (259/1048 v. 224/974 patient visits)."
"Patients 65 years and over whose visit was communicated without the benefit of the [system] were noted to have a 30% relative increase in the risk of a repeat visit within 28 days of their initial visit. Other measures of resource utilization in the emergency department, including mean length of stay (10.3 hours during the intervention phase v. 10.4 hours during the control phase) and number of tests (6.5 v. 7.0) and consultations (1.2 v. 1.2) requested per visit did not result in significant differences."
"More family physicians found the data received through the [system] legible, comprehensive and useful and as providing knowledge of the patient's emergency department visit."
"Nor were significant differences seen in resource utilization in family physician offices at follow-up.... There was no significant duplication of diagnostic tests between the emergency department and the family physician office during the intervention and control phases (24 v. 22, p = 0.93), but there was significantly greater duplication in specialty consultations in the intervention phase than in the control phase (20 v. 8, p= 0.049)."
Study Design
Randomized controlled trial (RCT)
Study Participants
The study participants included 2,022 visits of patients 18 and older from 23 family practices.